WITH DEFICIENCES OF VIEW
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The conclusions of the audit of the consolidated financial reports of the Ministry of Health as of December 31, 2023, were examined on July 12, 2024, during a session of the Court of Accounts of the Republic of Moldova (CoARM).
According to the audited financial reports, the assets managed by the Ministry of Health as of December 31, 2023, amounted to 3.5 billion lei, and actual expenses were 2.6 billion lei.
Audit evidence was collected from 18 entities consolidated into the Ministry of Health's financial report, and from 61 entities where the Ministry of Health holds the role of founder. These entities have responsibilities or are involved in policy development, administration, execution, reporting, and monitoring of assets and public funds in the health sector.
Following the audit of the consolidated financial reports of the Ministry of Health for the fiscal year ending December 31, 2023, the CoARM issued a qualified audit opinion, determined by the following:
- Undervaluation of the "Assets Taken on Lease/Rent" account by 26 million lei due to the failure to record the value of 18 land plots used by the National Public Health Agency in the off-balance sheet accounts. The ownership of these plots is registered with local public authorities. Additionally, 9 land plots valued at 21.9 million lei were incorrectly recorded in the "Land" account.
- Undervaluation of the "Buildings" account due to the failure to record in the accounting records by the National Public Health Agency of 4 buildings with a total area of 917.4 square meters and by 4 entities of 23 buildings with a total area of 1,893.1 square meters. The rights to these buildings are registered but not recorded in the Real Estate Register. The audit was limited in its ability to evaluate with certainty some real estate assets, which, according to estimates, amount to approximately 19 million lei.
- The audit was limited in determining the value of the undervaluation related to the "Shares and Other Forms of Capital Participation in the Country" account, but the audit estimates this undervaluation to be around 2.9 billion lei due to the incomplete registration of investments made from various sources (budget, donations, domestic and external loans, grants, own funds, etc.) by the Ministry of Health and other state entities in the infrastructure of institutions founded by the Ministry. This includes buildings that are part of the public domain of state property transferred under economic management. This situation was also caused by insufficient regulation in the methodological norms approved by the Ministry of Finance's Order No. 216/2015, in the chapter on accounting for assets transferred under economic management.
The audit identified issues related to the process of registering public assets transferred by the Ministry of Health in its capacity as founder, in the economic management of self-managed public institutions. In this context, it was found that out of 46 entities where the Ministry of Health is the founder and to which 131.5 million lei were allocated in 2023, 27 entities did not register the amount of 39.2 million lei transferred by the Ministry for the support of the technical-material base, reflecting these amounts as an increase in debts to the founder or in own capital.
For the year 2023, the costs of certain medical services were approved by a joint order of the Ministry of Health and the National Health Insurance Company, but these rates are not found in the Unified Tariff Catalogue, nor were they approved by a normative act. This lack of transparency and justification poses risks of over or under estimating the costs of medical services.
For the Public Institution "Coordination, Implementation, and Monitoring Unit of Health Projects," financial resources amounting to 138.9 million lei were approved in the state budget for 2023. Subsequently, without justification, the budget was adjusted to 132.3 million lei, which is 111.6 million lei less than the funds planned by the Global Fund (243.9 million lei). The audit reveals that the grant budget allocated by the Global Fund for the years 2021-2023 was 24.2 million euros, of which only 88% was utilized. Thus, the unutilized financial resources at the end of 2023 amounted to 1.8 million euros. The underutilization of financial resources indicates the reduced capacity of the Coordination Unit to fully absorb the external grant.
Additionally, the audit was limited in confirming expenses amounting to 71.1 million lei, recorded under the account "Services Not Attributable to Other Lines," which include prevention services provided by 22 public and private entities to beneficiary categories assigned to risk groups only through the National HIV Infection Prevention and Control Program. This situation was determined by the lack of supporting accounting documents that were supposed to be issued by NGOs, such as: invoices, information regarding the type of services provided, expense estimates related to the activities carried out, and others.
The audit found that the record of beneficiaries of HIV prevention services is kept by the HIV National Program Implementation Unit in an electronic register, the functionality of which is not regulated by normative acts. The national program provided for the development in 2022 from Global Fund sources (5.6 million lei) of an integrated information platform SIME HIV, but this system has not yet been developed and put into operation.
Educational services for fulfilling the state order were contracted by the Ministry with educational institutions (four medical colleges and one centre of excellence), amounting to 87.1 million lei for 2,048 students present at studies as of January 1, 2023, and 540 students planned for enrolment. Since only 504 students were admitted, the actual number of students present as of October 1, 2023, was 2,046. However, the ministry and educational institutions did not adjust the volume of allocated funds contracted to the actual number of students present at studies according to the current normative framework.
For 2023, medical educational institutions were required to employ 1,311 young specialists (377 students and 934 university graduates). In reality, the state order graduation plan was fulfilled at a level of 84%, or for 1,099 graduates (375 students and 724 university graduates, including 228 residents). It was noted that 228 residents of the Nicolae Testemițanu State University of Medicine and Pharmacy who were employed at the assigned workplace covered only 29% of the medical staff needs in 136 public entities, while 162 graduates of medical Colleges covered only 38% of vacant positions in 132 public entities.
The audit indicates that 26 graduates from the 2023 promotion and 33 graduates from the 2022 promotion of the Nicolae Testemițanu State University of Medicine and Pharmacy did not confirm employment at the workplace assigned by the Ministry of Health's Distribution Committee. Additionally, 73 students from the same university were expelled from state-funded studies in 2022-2023 for various reasons (unexcused absences, own-initiative withdrawal, etc.).
The Ministry and educational institutions did not take actions in accordance with the normative framework to recover to the state budget the educational costs amounting to 32.9 million lei, borne by the Nicolae Testemițanu State University of Medicine and Pharmacy for training the 132 expelled and unemployed persons. In these circumstances, it is obvious that training specialists at the expense of the state budget, in some cases, do not have an economic outcome or social impact.
In conclusion, the Court of Accounts mentioned that out of the 9 recommendations made in the previous audit, only 4 recommendations were fully implemented, 2 were partially implemented, and 3 were not implemented, leading to their reiteration in the current audit.
